tbuckley/cabot-search huggingface dataset:
Abstract 14816: Heart Failure Symptoms Are Associated With Markers of T Cell Activation and Tissue Remodeling
Authors: Brittany Butts, Erica Davis, Alanna A Morris, Sandra B Dunbar
Journal: Circulation (2022)

Introduction: Heart failure (HF) is a complex syndrome involving the interplay of pathophysiologic processes, such as inflammation and myocardial remodeling. T cell activation contributes to HF progression through cytokine release leading to cardiac fibrosis and hypertrophy. HF is characterized by physical symptoms that have been shown to predict morbidity and mortality. However, the pathophysiologic mechanisms driving symptoms are not well understood. Despite disparities in HF severity and morbidity among Black adults, relationships between inflammation and symptom burden are not well characterized in this population. Hypothesis: HF physical symptoms are positively associated with T-cell associated cytokines and chemokines. Methods: Black adults with HF (N=30) and LVEF &lt;50% were enrolled in this study. Symptoms were assessed with the PROMIS Dyspnea Severity Short Form 10a and Heart Failure Somatic Perception Scale (HFSPS). Biomarkers were measured via multiplex immunoassay. Results: The mean age was 55.38 ± 12.4 years, and 67% were female. Mean LVEF was 30 ± 13%. Dyspnea severity was positively associated with matrix metalloproteinase (MMP)-1 (r=0.412, p=0.041) and MMP-12 (r=0.496, p=0.014). HFSPS was positively related to cytokines associated with T-cell activation and differentiation [interleukin (IL)-1β (r=0.526, p=0.007), IL-6 (p=0.510, p=0.011), and IL-15 (p=0.528, p=0.019)], and with chemokines involved in T cell recruitment [C-C motif chemokine ligand(CCL)-11 (r=0.399, p=0.048), CCL-19 (r=0.421, p=0.036), C-X-C motif chemokine ligand (CXCL)-8 (r=0.528, p=0.007), and CXCL-11 (r=0.418, p=0.037)]. Conclusions: Somatic symptoms were associated with T cell-related cytokines and chemokines. Dyspnea was associated with enzymes that promote tissue remodeling and breakdown of collagen and elastin. These findings suggest tissue remodeling may play a role in HF symptoms, providing a potential therapeutic target for attenuating factors associated with HF symptom burden. Considering the pleiotropic nature of cytokines, further mechanistic work is needed for a better understanding of the pathophysiologic processes that could be targeted with interventions to reduce symptom burden in persons with HF.
Abstract 12985: Extensive Valvular and Mural (Endocardial) Papillary Elastofibromatosis
Authors: Vivek Modi, Leyla Gasimli-Gamache, Daniel Elmi, Santo Longo, Jamshid Shirani
Journal: Circulation (2022)

Introduction: Papillary fibroelastomas (PFEs) are benign, often isolated, valvular tumors of endocardial origin although they may originate from non-valvular tissue and can be multiple. We report a unique case of PFE that involved 2 cardiac valves and nearly entire left ventricular (LV) endocardial surface. Case: A 73-year-old white woman with a history of non-valvular atrial fibrillation was admitted with intermittent worsening headaches and loss of peripheral vision in the right eye. An occipital-parietal hematoma was detected on brain computed tomography. Transthoracic echocardiogram showed multiple mobile masses on the mitral valve and the subvalvular apparatus. Transesophageal echocardiography showed additional involvement of the aortic valve and LV endocardium and no otherpotential source of embolism. She experienced recurrent systemic embolism and underwent surgery for the removal of cardiac masses. At surgery, more than 40 loosely attached individual and clustered PFEs (some shown in Figures A and B) confirmed by histology (Figure C) covered both aortic (Figure D and E) and mitral (Figure F) valves and nearly the entire LV endocardial surface (including papillary muscles,Figure G). All LV masses were removed and aortic and mitral valves were replaced. Conclusion. Although cases of multiple valvular PFEs have been reported previously, we report a unique case with a large number of PFEs that involved 2 cardiac valves and the entire mural surface of LV. We have used the term papillary elastofibromatosis to describe such an extensive tumor growth.
Abstract 14801: Protective Associations of Dairy Foods and Cardiometabolic Markers Differ by Food Type and Fat Content: The Boston Puerto Rican Health Study
Authors: Kelsey M Mangano, Sophie Kenny, Xiyuan Zhang, Sherman Bigornia, Josiemer Mattei, Katherine L Tucker
Journal: Circulation (2022)

Introduction: The relation of dairy intake with cardiometabolic (CM) markers remains unclear due to a complex nutrient profile across dairy types. This study aimed to evaluate associations between dairy intake and CM markers among Puerto Rican adults with excessive CM burden. Methods: Baseline and 2-y follow-up data on diet and CM markers were available for 1110 participants aged 46-78y. Diet was assessed with a validated food frequency questionnaire. Dairy groups (total, milk, yogurt, cheese, cream, total with any fat, total without fat) were created from disaggregated foods and presented as servings/d/2000 kcal (s/d). Mean dietary intakes across two visits were used. CM biomarkers were assessed from fasted blood at 2-y and included waist circumference (WC), HDL and LDL cholesterol, TG, insulin, HbA1c, HOMA-IR, homocysteine (Hcy), C-reactive protein (CRP), blood pressure (BP) and Framingham risk score (FRS). Generalized linear and logistic regression were used to determine associations between dairy variables and each CM marker, adjusted for age, sex, BMI, kcal, alcohol and fruit /vegetable intakes, CVD/diabetes medications, language acculturation score, smoking, perceived stress, and physical activity. Multiple comparisons were adjusted by FDR correction. Results: Mean age was 59.3±7.7y, 70% female, 80% with metabolic syndrome. Total dairy intake was 2.3±1.1 s/d; 2.1±1.0 from dairy with fat and 0.2±0.5 without fat. Total dairy, dairy with fat, and milk intakes were associated with lower Hcy (β -0.37, SE 0.12, P =0.0012; β -0.39, SE 0.13, P =0.003; β -0.42, SE 0.13, P =0.002; respectively); non-fat dairy with lower WC (β -1.41, SE 0.44, P =0.001); milk with lower odds of high BP (OR 0.84, P =0.04); cheese with lower TG (β -18.5, SE 9.2, P= 0.04); yogurt with lower HbA1c (β -0.46, SE 0.17, P =0.008); cream with lower HbA1c (β -0.20, SE 0.10, P =0.04) and HOMA-IR (β -1.33, SE 0.56, P =0.02). No associations were seen with cholesterol, CRP, insulin, or TG. After FDR correction, findings remained significant for total dairy, dairy with fat, and milk with Hcy. Conclusions: Protective associations of dairy with specific CM markers vary by type of dairy and fat content. Associations were independent of overall dietary pattern and other risk factors for CM disease.
Abstract 14123: AF Ablation Using a Novel “Single-Shot” Map-and-Ablate Spherical Array Pulsed Field Ablation Catheter: Impact of Application Repetition on PV Isolation Durability in the <i>PULSE-EU Study</i>
Authors: Vivek Y Reddy, Mohit K Turagam, Jan Petru, jacob s Koruth, Moritoshi Funasako, Pavel Hala, Jan Skoda, Milan Chovanec, Lucie Sediva, Petr Neuzil
Journal: Circulation (2022)

Introduction: Preclinical studies have revealed that pulse field ablation (PFA) lesion dimension increases with consecutive applications at a similar electric field. Whether durability of pulmonary vein isolation (PVI) is predicated on repetitive PFA applications is unknown. In the first-in-human PULSE-EU clinical trial (NCT05164107), the ability of this map-and-ablate PFA catheter to achieve durable PVI was assessed, both with single vs repetitive PFA applications. Methods: Under general anesthesia, paroxysmal AF pts underwent PVI using the spherical array PFA catheter (Globe; Kardium Inc, Canada) delivered with a deflectable 19Fr transeptal sheath and ICE-guidance. Using a custom mapping system, the PFA catheter rendered contact and voltage anatomic maps ( Figure ). The spherical array is positioned at the PV ostium and PFA is performed (1.6-2 kV/lesion, ungated 3s pulses). Follow-up was post-procedure EGD and brain MRI within 1 day, and invasive remapping at ⁓2 months. Results: A total of 21 pts (age 63±11 years; M/F 33%/67%) underwent PVI in 2 groups: Gp1-single PF application/PV, and Gp2-3 PF applications/PV. In Gp1 (n=11 pts) and Gp2 (n=10 pts), PVI was acutely successful in 100% of PVs in both groups. Pulse delivery times and total procedure times were 75.2±7.4 sec/pt vs 24.5±5.5 sec/pt and 73.2±13.7 mins​ vs 93.7±18.5 mins​ in Gp2 vs Gp1. There was no stroke/TIA, pericardial effusion, phrenic nerve injury, or esophageal complications. EGD was normal in all 9/9 pts. Brain MRI showed silent cerebral lesions (DWI+/FLAIR-) in 3/16 (18.8%) pts. PV remapping revealed durable PVI in 25/40 (62.5%) PVs in 10 pts in Gp1, compared with all 34/34 (100%) PVs in 9 pts in Gp2; this translates to all PVs being durably isolated in 27% vs 100% (p&lt;0.05) of pts in Gp1 and Gp2. Conclusion: The “single-shot” map-and-ablate spherical array PFA catheter can safely isolate PVs. Repetitive PFA applications is key for lesion consolidation to improve PVI durability.
Abstract 14057: Detection of Left Ventricular Systolic Dysfunction From Electrocardiographic Images
Authors: Veer Sangha, Arash Aghajani Nargesi, Lovedeep Dhingra, Bobak Mortazavi, Antonio H Ribeiro, Evgeniya Banina, Cynthia Brandt, Edward J Miller, Antonio Ribeiro, Eric J Velazquez, Harlan M Krumholz, Rohan Khera
Journal: Circulation (2022)

Background: Left ventricular systolic dysfunction (LVSD) is associated with an over 8-fold risk of heart failure and 2-fold risk of premature death. Echocardiographic screening is limited by access to the technology, and artificial intelligence-based tools have been limited to ECG signals, precluding access by end users. Methods: A total of 393,910 12-lead ECGs from patients undergoing echocardiography at Yale were used to develop a model identifying LV ejection fraction &lt; 40% in printed ECG images, using a EfficientNet-B3 convolutional neural network with transfer learning. The algorithm was validated using real-world ECG images. To allow interpretability, gradient-weighted class activation mapping (Grad-CAM) was used to localize class-discriminating signals in the images. Results: A total of 60,293 ECGs (15.3%) were performed in patients with LVSD. The ECG-based image identified LVSD accurate across multiple image formats in the held-out test set (AUROC 0.91, AUPRC 0.69), and in two external sets of real-world ECG images from an outpatient academic center (AUROC 0.93, AUPRC 0.69) and a rural hospital system (AUROC 0.91, AUPRC 0.89). An ECG suggestive of LVSD portended over 24-fold higher odds of LVSD in the held-out set (OR 24.4, 95% CI, 22.4-26.6). Regardless of the ECG layout, class-discriminative patterns from Grad-CAM localized to leads V2 and V3, corresponding to the left ventricle. Moreover, a positive ECG screen in individuals with LV ejection fraction &gt; 40% at the time of initial assessment was associated with 4-fold increased risk of developing incident LV systolic dysfunction in the future (HR 4.3, 95% CI 3.9-4.7, median follow up 2.3 years). Conclusions: We developed and validated a layout-independent deep learning model that identifies LVSD from images of ECGs. This approach represents an automated and accessible screening strategy for LVSD, particularly in low resource settings.
Abstract 14229: Utilization of Calcium Scores to Predict TAVR Outcomes in Paradoxical Severe Aortic Stenosis
Authors: Ralph Cipriano, Mehak Kapoor, Andrew Corrigan, Gregory Grinberg, Stanley Aladi, Shahidul Islam, Richard Schwartz, Khaled Salhab, Scott Schubach, Kevin Marzo, Beevash Ray
Journal: Circulation (2022)

Introduction: In patients with severe symptomatic (Stage D) aortic stenosis (AS), the disease is subcategorized based on the gradient, flow and left ventricular ejection fraction (LVEF). Stage D3 reflects low-flow, low-gradient severe AS with normal LVEF (paradoxical low-flow severe AS [PLFLG AS]. Current guidelines suggest measurement of a Computed Tomography (CT) derived calcium score of the native valve is helpful for management. Furthermore, calcium score can provide prognostic information for transcatheter aortic valve replacement (TAVR) in the general AS population. However, whether CT-derived calcium scores can predict major adverse cardiovascular events (MACE) in PLFLG AS patients undergoing TAVR has not been examined. Methods: We retrospectively investigated post-TAVR outcomes at 1 year, in patients echocardiographically characterized as PLFLG AS at our center between Jan. 2017 and Dec. 2020. Continuous variables were assessed for normality using the Kolmogorov-Smirnov test, histogram, and Q-Q plot. Logistic regression models were used to assess if calcium scores were associated with outcomes, and statistical significance was assumed if p&lt;0.05. Results: : A total of 85 patients were included in the analysis. The baseline pre- and immediately post TAVR data are described in Table 1. In our cohort, 16 had MACE (18.8%) at 1 year. Calcium score as a predictor of MACE (odds ratio (OR): 0.99; p=0.93), death (OR: 0.99; p=0.79), stroke (OR 1.01; p=0.90), myocardial infarction (OR 0.97; p=0.63), and post-TAVR paravalvular aortic regurgitation (OR 1.02; p=0.47) did not reach statistical significance. Conclusions: In our cohort, CT-derived calcium scores did not predict MACE events or post-TAVR paravalvular aortic regurgitation in PLFLG AS. The study had several limitations: it is a single center retrospective study with a small sample size, potentially leading to recording bias.
Abstract 13500: Real-World Healthcare Resource Utilization Outcomes With Dronedarone versus Sotalol Following Ablation in Adults With Atrial Fibrillation
Authors: Emily P Zeitler, Dara Stein, RON PREBLICK, Shaum M Kabadi, David MCKINDLEY, Jason Rashkin, Samuel Huse, Nicole Stamas, Michael H Kim
Journal: Circulation (2022)

Introduction: Dronedarone has shown clinical benefit vs sotalol in adults with atrial fibrillation (AF) post-ablation, but healthcare resource utilization (HCRU) in this setting is unknown. Methods: A retrospective, observational cohort study was conducted using IBM MarketScan® data (Jan 2012-Mar 2020) in adults with AF receiving dronedarone or sotalol post-ablation. Patients needed to have 12 months of pre-ablation data; follow-up ended at earliest of health-plan disenrollment, death or end of study (Dec 2020). Prevalence (events per 100 patient-years [PY]) was calculated for all-cause and cardiovascular (CV)-related HCRU (hospitalizations; emergency room [ER] visits; outpatient office visits; other outpatient services). Patients receiving sotalol were propensity score (PS)-matched 1:1 to patients receiving dronedarone and compared by univariate generalized linear models with Poisson distribution. Time-to-event (TTE) cumulative incidences for all-cause, CV-related and atrial tachyarrhythmia (ATA)-/AF-related hospitalization, and for pacemaker insertion, were compared by Kaplan-Meier analysis and log rank test. Results: After PS-matching, the dronedarone and sotalol (n=1600 per cohort) cohorts were successfully matched across several criteria (mean follow-up: ~28 months; age at ablation: ~61 years; proportion male: ~70%; hypertension: ~71%; heart failure: ~13%; mean CHA2DS2-VASc score: ~1.8; mean Charlson comorbidity index: ~0.8). Post-ablation, prevalence per 100 PY of all-cause hospitalization (24.0 vs 27.4), ER visits (53.1 vs 59.5) and other outpatient services (1140.1 vs 1184.5), and of CV-related hospitalization (8.4 vs 11.3), ER visits (8.5 vs 10.0) and outpatient office visits (379.6 vs 390.9), were significantly lower with dronedarone vs sotalol. Cumulative incidences were significantly lower with dronedarone vs sotalol ( Figure ). Conclusions: Post-ablation dronedarone was associated with lower HCRU vs sotalol.
Abstract 14322: Sex Differences and Clinical Outcomes in Patients With Myocardial Infarction With Non-Obstructive Coronary Arteries. A Meta-Analysis
Authors: Jia Ee Chia, Tong Hong Chia, Song Peng Ang
Journal: Circulation (2022)

Introduction: While myocardial infarction with non-obstructive coronary arteries (MINOCA) is more common in women, it is unknown whether female sex is a risk factor for adverse outcomes in patients with MINOCA. We aimed to investigate the relationship between sex differences and outcomes of patients with MINOCA by a meta-analysis Methods: A systematic literature search was performed in PubMed, Embase and Cochrane databases from its inception until June 2, 2022 for relevant studies. Endpoints were pooled using the DerSimonian and Laird random-effects model as odd ratio (OR) with 95% confidence intervals (CI). Results: 6 studies with 28,383 patients with MINOCA (11,223 men, 17,160 women) were included in the analysis. There was no significant difference in terms of all-cause mortality (OR 1.03, 95% CI 0.91-1.17, p=0.66), major adverse cardiovascular events (MACE)(OR 0.87, 95% CI 0.74-1.02, p=0.09), incidence of heart failure (OR 1.09, 95% CI 0.89-1.34, p=0.42), stroke (OR 1.09, 95% CI 0.89-1.34, p=0.42) and myocardial infarction (OR 1.09, 95% CI 0.89-1.32, p=0.41). Subgroup analysis based on follow-up period showed that men had a lower risk of MACE than women in subgroups of less than 1 year (OR 0.75, 95% CI 0.65-0.87, p=0.41) compared to that of more than 1 year (OR 0.97, 95% CI 0.87-1.09). Conclusion: Apart from lower short-term risk of MACE in men, there appears to be no significant sex-specific differences in the outcomes among patients with MINOCA.
Abstract 13066: Mortality Differences Between Urban and Rural Hospital Admissions for Left Atrial Appendage Occlusion
Authors: Sahith Reddy Thotamgari, Akhilesh Babbili, Stephen P Seslar, Christopher V Desimone, Abhishek Deshmukh
Journal: Circulation (2022)

Introduction: There is a variation in cardiovascular outcomes between rural and urban hospitals such as higher mortality for AF. Whether such a relationship exists for safety and outcomes of left atrial appendage occlusion (LAAO) device implantation is unknown. Hypothesis: We hypothesized that LAAO procedure in rural hospitals is associated with worse in-hospital outcomes. Methods: A cross-sectional examination of patients who were hospitalized for LAAO procedure was performed in the National Inpatient Sample between 2016 and 2019 to compare in-hospital outcomes in patients admitted to urban vs rural hospitals. ICD 10 PCS code 02L73DK was used to identify hospitalizations with LAAO procedure. The cohort was further stratified into rural and urban hospitals. Chi-square test and multivariate logistic regression were used to analyze the association and statistical analyses were performed using weighted values. Results: A total of 61,390 hospitalizations for LAAO procedures were identified during the study period. From these, 1185 (1.93%) hospitalizations occurred in rural hospitals. Baseline characteristics and inpatient outcomes are shown in Table 1. LAAO in rural hospitalizations was associated with significantly higher in-hospital mortality [OR 2.94 (1.17-7.14), p&lt;0.001*]. This associated persisted even after adjusting for significant baseline characteristics [aOR 3.55 (1.42-8.84), p=0.006*). Conclusions: In-hospital mortality was significantly higher in patients undergoing LAAO in rural hospital. Further studies are needed to validate these findings in a prospective manner.
Abstract 14218: Social Isolation Decreases Survival and Worsens Cardiac Function in a Novel Murine Model of Coronary Atherosclerosis
Authors: Danielle M Mullis, Hanjay Wang, Yuanjia Zhu, Spencer Bonham, Amanda S Padilla Lopez, Olivier N Kocher, Monty Krieger, Y. Joseph J Woo
Journal: Circulation (2022)

Introduction: With more people working from home after the COVID pandemic, it is of utmost importance to further understand the impact of social isolation on outcomes of patients with coronary atherosclerosis. Our preliminary studies have shown that the novel diet-inducible, fatal mouse model of coronary atherosclerosis, SR-BIΔCT/LDLR KO , tend to die on average around 4-6 weeks after starting a high-fat Paigan diet (HFD). This mouse model can be used to further understand the effect of social isolation on cardiovascular disease. We hypothesize that social isolation will decrease survival and worsen cardiac function. Methods: Male and female SR-BIΔCT/LDLR KO mice were put into social isolation (n=11), in a group of 2-3 (n=13), or in a group of 4-5 (n=22). At six-weeks-old, mice were started on a HFD to induce pathology. Echocardiography was performed to assess cardiac function. Analysis was performed using one-way Analysis of Variance tests and hoc-Tukey’s Honest Significant Difference tests. A log-rank test was used to calculate the difference in survival distributions. Results: Mice living in groups of 1, 2-3, and 4-5 lived for an average of 34.9, 35.6, and 41.5 days, respectively, after starting the HFD ( Fig. 1A ). The survival distribution is significantly different between the mice in isolation versus the mice in groups of 4-5 (p&lt;0.01). Mice in social isolation have significantly lower ejection fractions than mice living in groups of 4-5 after two weeks of being on the HFD ( Fig. 1B , p=0.028). Conclusions: Mice in social isolation exhibited decreased survival and reduced ejection fractions compared to mice in groups of 4-5. More mice would be needed to determine whether single isolation is different from mice in groups of 2-3. Further studies should be performed to understand the mechanism underlying the effect of social isolation on heart function. Such studies may influence future prevention strategies to positively affect outcomes of patients with atherosclerosis.
Abstract 12800: Mathematical Modeling of Myocardial Transthyretin Amyloid Deposition and Clearance
Authors: Ashley F Stein-Merlob, Lihua Jin, alan garfinkel
Journal: Circulation (2022)

Introduction: In vitro transthyretin amyloid (ATTR) fibrillation kinetics are well studied, however, the in vivo interplay between ATTR fibrillation and clearance causing cardiac amyloidosis (TTR-CA) is underexplored. We investigated these interactions using a mathematical model of ATTR deposition. Methods: We divided the mechanisms of ATTR deposition from tetramer to clearance by clusterin (an extracellular chaperone) into individual reactions (Fig. 1A) with 7 parameters. A system of ordinary differential equations (ODEs) describes the change in ATTR monomer, fibril, inhibitor, and complex deposition. Parameter values were determined using published experimental data and equilibrium analyses. We model an FDA-approved stabilizer, Tafamadis, by modifying S(t), the source term for production and dissociation of tetramers, as a step function downward at therapy initiation. Alternatively, a linear function S(t) models the hypothesis that senile TTR-CA is triggered by age-related wtTTR instability from oxidation. Results: The ODEs simulated a biologically meaningful model of TTR-CA. Equilibrium analyses found three phenotypes. (1) One stable, low equilibrium point representing normal myocardium (low S, high Ki). (2) Three equilibrium points, with 2 stable points (low and high) and a middle, unstable saddle point, indicating susceptibility to perturbation into a state with significant ATTR (low S/Kc2, high Ki/Kc). (3) No equilibrium points causing unbounded ATTR (high S, low Ki). In the Tafamadis model, ATTR fibril reduction was proportional to drug efficacy (Fig. 1B). Senile TTR-CA model showed rapid progression of cardiac ATTR deposition with onset dependent on slope of S (Fig. 1C). Conclusions: This mathematical model predicts physiologic ATTR clearance and pathological ATTR deposition with a limited number of parameters. It is a hypothesis generating model that can elucidate mechanisms of TTR-CA pathogenesis and investigate future therapies.